Indications and Prognostic Factors of Groin Flap for Reconstruction of the Extremities

There are several advantages for groin flap, but its small and unpredictable vessels of pedicle have made it to lose its initial popularity. Although it would be ideal flap when it is focused on its useful advantages such as relative larger size, low donor site morbidity and possible bone graft, there have been few studies for prognostic factors for successful groin flap. Authors intended to determine prognostic factors which are relative with success of free groin flap. From January 1985 to December 2007, 107 patients who underwent groin flap for reconstruction of extremities were selected consecutively. Univariate and multivariate analysis were performed to determine prognostic factors which were related with success of groin flap. Eighty of 107 (74.8%) flaps survived. There was significant difference in success rate according to the recipient site. Nineteen of 20 cases (95%) survived in upper extremities, but 61 of 87 cases (70.1%) survived in lower extremities, which was statistically significant (p=0.022). Univariate analysis showed that mean diameter of donor veins was significantly larger in success group (p=0.021). Groin flap is recommended for reconstruction of upper extremities than lower extremities. It is thought to be critical that surgeons try to match vessel diameters between donor and recipient site.

Reconstruction of injured hand with microsurgical technique / 대한정형외과학회잡지

No abstract available.

A Clinical Study of Lumbar Spinal Stenosis / 대한정형외과학회잡지

Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Routine conventional radiographs or sagittal tomographs cannot accurately assess the midsagittal diameters of the lumbar canal or detect encroachment on the canal by osteoarthritis articular facets. However, myelography and computed tomography provide a means for distinguishing between herniation of a disc and bony encroachment on the spinal cord. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurological functi ions. The surgical strategy is based on the patients symptoms and roentgenographic findings. Eighty-two operative cases of lumbar spinal stenosis were analyzed who were admitted in the Department of Orthopedic Surgery at Yonsei University College of Medicine from January, 1979, to July, 1984. The male female ratio was 1.3:1 and 66 cases (80.5%) included in their 50's and 60's. The results of the study are as follows: 1. Clinical symptoms included aggravation of pain during back extension (28.0%); back pain with radiating pain (22.0%); paresthesia of extremities (18.3%); back pain only (13.4%); and claudication (12.2%). 2. On physical examination, the straight leg raising test showed positive results in 25.6%, motor changes occurred in 24.4%, sensory changes in 20.7%, and DTR changes in 11.0%. 3. The most frequent level of spinal stenosis, L5-Sl invertebral space, was found in 68.3%(56cases) followed by L4-L5 intervertebral space found in 61.0% (50 cases). 4. Operative findings induded 31 lesions (46.3%) identified as herniated or ruptured discs,20 lesions (29.9%) identified as thickening of lamina and ligamentum flavum, and 5 lesions (7.5%) as compression of a nerve root by scar adhesion. 5. Of the 67 patients (81.7%) operated through the posterior surgical approach, 52 cases (77.6%) were effective; and of the 15 patients operated on by the anterior surgical approach, 9 cases (60.0%) were effective. 6. When the duration of symptoms was less than 1 year and the involved level of spinal stenosis was less than 2, operative results were satisfactory. 7. When there was a degenerative type of stenosis without a herniated or ruptured disc, operative results were excellent. 8. For post operative external support, 32 cases (39.0%) wore body jacket cast and 38 cases (46.3%) wore back braces.

Clinical Effects of Diadynamic Currant for Patients with Pain in the Back and Extremities / 대한정형외과학회잡지

The treatment of pain in the back and extremities remains empirical. The application of surface electrodes to the dorsal columns of the spinal cord has been used by Shealy. The rationale. for dorsal column stimulation has been the “gate control theory” of pain proposed by Melzack and Wall. Transcutaneous electrical nerve stimulation is well recognized for its effectiveness in pain relief. The authors studied 48 cases of group A (physiotherapy, medication) and compared them with 43 cases of group B(physiotherapy, medication 'and diadynamic current), in the Department of Orthopedic Surgery, Yonsei University Hospital, from April, 1983, to June, 1984. The results were as follows: 1. Significant relief of pain was noted in group B in long term follow up of acute pain in the back and extremities. 2. In long term follow-up of group B, there was more improvement than in group A, especially when there was radiating pain in the extermities with or without back pain. 3. In long term follow-up according to the causes of the pain, there was more improvement in group B than in group A in cases of herniated nucleus pulposus and low back syndrome. From a consideration of these studies, it was concluded that satisfactory results were obtained from diadynamic current treatment for the patient with pain in the back and extremities.

A Clinical Study of the Radial Nerve Paralysis Associated with the Humeral Shaft Fracture / 대한정형외과학회잡지

Radial nerve paralysis associated with humeral shaft fracture is the most common peripheral nerve lesion complicating fractures. The mechanism of injury, treatment, and prognosis of radial nerve paralysis associated with fracture of the humerus vary considerably, depending on when the nerve injury occured with respect to the humeral fracture and its subsequent treatment. A clinical study was performed on 243 patients with fractures of the humeral shaft. Especially fourty two cases of radial nerve paralysis associated with fracture of the humerus were analyzed at Department of Orthopedic Surgery, Yonsei University College of Medicine from January 1965 to December 1982. The results were summarized as follows: l. Among 243 humerus shaft fractures, the ratio of male to female was 2: 1. The common cause of radial nerve paralysis associated with humerus fracture were due to traffic accident and industrial machine injury. The closed fracture was 205 cases(84.4%) and the most common type of fracture was comminuted fracture(52.6%) 2. Among 243 humerus shaft fractures, 42 cases(17.3%) complicated the radial nerve paralysis. The radial nerve paralysis was the most vulnerable to injury at the distal third of the humerus, especially when there was open or comminuted fracture. The incidence of primary radial nerve paralysis was 8%(34 cases), and 19#g(8 cases) in secondary radial nerve paralysis. 3. Among 42 radial nerve paralysis associatd with humerus fractures, 15 cases were treated by conservative method. And 27 cases were treated by surgical exploration. By surgical exploration the practical cause of radial nerve paralysis were found: 13 cases negative, 5 cases contusion, 3 cases stretching. The recovery sign of radial nerve paralysis was noted from 2 weeks after treatment. Spontaneous neurological recovery was not noted beyond 6 months after treatment. Thirty two patients were available for follow up study. The overall recovery rate of radial nerve paralysis was 81.3. The practical causes of patient with no recovery of nerve function were cross section of nerve, severe stretching or entrapment of radial nerve between the sites of fracture. From a consideration of these series, it was concluded that satisfactory result was obtained from conservative management in humerus shaft fracture associated with radial nerve paralysis. Indication of early surgical exploration of radial nerve paralysis associated with humeral fractures are open fractures requiring debridement, spiral or oblique fractures with marked displacement, and progressive nerve paralysis.